HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �; �, � �OCi Permit Number: Oko
RECETVEt� --
_____ Building Permit Applicatio FEB 2 7 K;20
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting i
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _
PERMITTYPE:
P50P05E-U IMPROVEMENT LOCATION:
Address: g0c( -7 SIM IG: 04- Ln
Property Tax ID #: �04�' o 00 . io Lot No. s
Site Plan Name: Block No.
Project Name:
Additional work to be performeIJ under this permi -check all that apply:
_Mechanical _Gas Tank �/GasPiping _Shutters —Windows/Doors
_ Electric _Plumbing - _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 5 , DOB.
Sq. Ft. of First Floor:_
Utilities: _Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ZC Cry `C-er...,c� :., ',
Name:
-
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Address:79aJ S keJe(o e4o.e GTtG '
Company: 96i t.
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City: /, t- State: FL
Zip Code: tl4 $ Fax:
Phone No.
AddressA: 7)1 5 LJ 6-P0.'�
Ex� _ < < ✓
City: D S• L
Zip Code: ,)c/9 ,? &
Phone No 770- 4 3 7 -
Fax:
SDod
State: rt
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail BanZA P1 u
@ 6r -: /, Can
State or County License C c Na yos i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
MR.P.LMcos
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MORTGAGE COMPANY: _ Not Applicable
Name:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF • L ocl,tc
The,fetggin Y nstru w ledged re me
thisC> Ida of 2
Name of person makil tatement. /
Personally Known OR Produced Identification V
Type of Ideft4fitation,,
REVI
L7atL:
DATE
KAREN S.NIEL
ite of Florida-Notar
ommission # Ub 2
My Commission E:
Signature ofContractor/License Holder CSTATEOUNTY
OF FLORIDA t F 1 ,^ �
COUNTY OF �j �.J�li
Thelog4nginstru knowledged before me
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'day of , 2(i
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Name of person making tatement.
Personally Known OR Produced Identification
Type of Identifc
Produced
um
(Signature of t Iq�i f)ELSEN
lorida-Notary public = . Commission #
Commission N y COmmiec�
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COUNTER REVIEW I S UPERVISREVIEWOR I REVIEW PLANS I VEGETATION REVIEWI SE EV EWTURTLE I MANGROVE